Do most children invent stomach aches from time to time, to get off school? How can you distinguish between a genuine sick child and one who creates phantom pains?
Conventional remedy
Tummy pain is one of the most common childhood complaints. Often what a child calls a stomach ache may not involve the stomach at all, but signal a problem in the urinary tract, bowel, appendix, lungs or even throat. The causes of abdominal pain are as varied as the nature and location of the pain.
For most children, the cause is usually something simple and self-limiting. These include gastroenteritis, constipation, urinary-tract infections, strep throat and indigestion.
Tummy ache can also be a child's response to emotional distress or anxiety, however. A recent move, family tensions, pressure or problems at school can all cause tummy problems. Frequent stomach aches can be a sign of depression in children.
Tummy pain may be accompanied by other symptoms, which can help to pinpoint the source of the problem. These can include poor appetite, nausea, vomiting, diarrhoea, pain on urination or bowel movement, crying and additional pain in the back, chest, scrotum, rectum or legs.
You should seek advice from your doctor if the pain is severe and lasts more than an hour, the pain is on the lower right side of the abdomen, your child has a temperature or is vomiting frequently, there is blood in the urine or bowel movement, your child was injured in the abdomen or you suspect poisoning.
Less common causes of tummy pain include appendicitis, food allergies, hernia, anaemia, reflux ulcers or intussusception (a telescopic blockage in the intestine).
In my experience, most parents have a sixth sense when it comes to serious illness in their children. If you have any doubts, you should seek medical advice.
Dr Muiris Houston
Alternative remedy
First, you must rule out a physical basis for the tummy pain; a full medical paediatric examination should be carried out for recurrent abdominal pain. Second, you should realise that we operate a false duality of mind and body.
In fact, the two are connected, and psychological fear or anxiety can produce a real physical pain. In children, these are often the equivalent of what adults experience as tension headaches.
We sometimes think children are making up these pains, but there are children who have real pains and not just a Monday-morning pain that you can persuade them out of. It may help if you ask them what it would take to make the pain go away.
Recurrent abdominal pain occurs in 10-20 per cent of the school-going population and is usually associated with stress, anxiety and family experiences of and attitudes to illness. Equally common in boys and girls, it is most common among five- to 12-year-olds.
About a third of these children may go on to suffer with migraine in adulthood and seem to be biologically predisposed to somatic problems. The tummy pains usually occur during the day and rarely at night.
If there is an ongoing pattern of tummy pain and it lasts for a significant time, you need to think about what might be putting the child under stress, at school or at home.
Are there any significant changes in childminding arrangements, for example, or with teachers or other pupils? Is there a problem with bullying?
When children have anxiety symptoms, we often look outside the home for their source. But they are often brought on by a problem within the home, and may even be a way of responding to loss or bereavement.
Sometimes it can be hard to pinpoint the cause of the stress, but helping the child to cope with worries and have stress-free outlets is useful.
Looking at factors that might be maintaining the problem is also useful; sometimes we can inadvertently reward illness or feed the process with our own anxiety.
If parents can't sort out the problem on their own, it can be useful to talk it through with their GP or seek a referral to their local child-guidance clinic.
Remember that there is always a meaning to a child's behaviour, symptoms or pain. It may not be an obvious one, but it is communicating something. Usually, it signals stress or anxiety, but sometimes it can be a more serious cry for help.
Deirdre MacIntyre
Deirdre MacIntyre is a clinical psychologist who works with children
The advice in this column is not intended as a substitute for advice received directly from a medical doctor or alternative practitioner. You should receive a thorough diagnosis before embarking on any course of treatment